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r1r�-,t�� ifkent <br /> { — � I.'C�(l(r�" ["ltr� I- f'C!�'i_ { ,. <br /> Mo itoring \IUell/Sail Boring Inspection report <br /> 12 . 1 Gam' � CONSTRUCTION <br /> Date. I� ( � Inspector � <br /> Facility Address: Igfl 1�� �� 00 Z AJ2 <br /> Well Address: IIA Q."t JCq Total Depth: <br /> WP# ? Well#: Drilling Rig Type: <br /> Soil Boring#: Al Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: JR4 <br /> Driller Onsite QLI` Screen Length From: To: <br /> Consultant: Q 11 Filter Pack From: To: <br /> Geologist: IBentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> czsirg <br /> If yes, location and distance: �� height <br /> SAMPLING AROVE_o Rte,-t„D <br /> �\ <br /> Holding Temperature: ca&v=JON CJC�?.iF�f1oN <br /> Method: <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No _— o <br /> If yes,spoils storage Location: — <br /> aJa:.E-d t <br /> Covered: ❑ Yes I-]No = <br /> If yes, material: ((',, <br /> GROUTING or DESTRUCTIO Total Depth:_�Yt - <br /> Depth to Water: m------ft. c---- — �- <br /> Grout Material: V cd k 0"d U n%t,4,i MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: L 3g%- (ID"') - <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation VBoring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> EVGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 11) !Natal• cement 941b <br /> gallons Bags oallons Bags <br /> TI-Od:est Thinnest 4 Bags Thickest Thinnest ^Bags BentonitelCer a€nt Mix 3% Mix 5% N iX <br /> 2.5 5 I 1 5 10 I i Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> .5 15 3 15 30 3 <br /> 10 20 420 40 4 <br /> 12.5 25 525 50 S /� ( \ <br /> 1. 25 F0 60 6 I! q,,J <br /> 17.5 35 735 70 <br /> 20 40 8-111--40 I 20 E . _ _. Ce �I 1 I I <br /> 4 `�� 0/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 1 kvww.sicehd.com <br />